Healthcare Provider Details

I. General information

NPI: 1548727985
Provider Name (Legal Business Name): ANNAMARIA KEKESI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 BROOKMEADE DR
CRESTVIEW FL
32539-6029
US

IV. Provider business mailing address

2104 LEWIS TURNER BLVD
FORT WALTON BEACH FL
32547-1316
US

V. Phone/Fax

Practice location:
  • Phone: 850-612-6167
  • Fax:
Mailing address:
  • Phone: 850-862-3728
  • Fax: 850-862-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-78981
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: